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Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
In instances of recurrent and/or intractable nausea and vomiting, lab work should be performed and patients may require intravenous hydration, antibiotics for infection, and/or hospitalization to manage severe dehydration and/or electrolyte imbalances. First and second-line antiemetics such as ondansetron (Zofran), scopolamine patches, prochlorperazine (Compazine), Metoclopramide (Reglan), and palonosetron (Aloxi) should be considered, as well as other classes of drugs such as cannabinoids tetrahydrocannabinol (Marinol), corticosteroids (dexamethasone), benzodiazepines (Ativan), and off-label use of low-dose haloperidol (Haldol).73,74 For individuals unable to maintain adequate caloric intake for prolonged periods of time, a nasogastric tube may be inserted for temporary nutritional support if the patient and/or family wishes (see Appendix 1 for Advance Directives). For individuals experiencing dysphasia, and/or the inability to keep medication down by mouth in pill form, alternate routes of administration for antiemetics (and other prescribed medication) should be considered (i.e. injection, rectal suppository, oral liquid concentrates, sublingual [under the tongue], and buccal [between the gums and cheek]). Signs and symptoms of infection, including elevated body temperature, should be monitored to assess for conditions such as sepsis. In the presence of nausea and vomiting in conjunction with abdominal pain, bloating, and reduced bowel sounds and function, medical evaluation for conditions such as bowel obstruction should be performed.
Disorders of the digestive tract
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Hospital based treatment is indicated if the woman’s symptoms are not controlled by oral antiemetics prescribed by the GP. Day care management is preferable depending on the woman’s condition, with inpatient treatment indicated when nausea and vomiting continue despite initial medication, inability to tolerate oral antiemetics, excess of 5% weight loss and any co-morbidities. The RCOG9 provides a list of antiemetic medications that have been evaluated regarding the safety of use in pregnancy. The prescribing doctor will need to discuss medication options with the woman. Historical fears regarding the use of thalidomide and the associated congenital abnormalities in the late 1950s and early 1960s have made people understandably cautious of medication in the first trimester16. Evidence of safety, probability of risk and benefits of treatment will need to be discussed to ensure informed consent. When oral medication is not tolerated, alternative routes of administration, including IV, rectal, subcutaneous and IM will be used. IV hydration will be required with correction of any electrolyte imbalance9. The midwife should keep accurate records of fluid balance to assess for dehydration and response to treatment. Daily assessment of urea and electrolytes will be required. Regular assessments of observations plotted on a MEOWS chart is recommended with prompt referral indicated for any deteriorating condition17. When an inpatient, women will need to be cared for in a side room away from where food is being prepared.
Pulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Charles S. Dela Cruz, Barbara Seaworth, Graham Bothamley
Once liver toxicity is excluded as the cause of gastrointestinal upset, a variety of approaches can be used. Patients can be encouraged to take a short nap after the medication as most often they are still on home isolation when initially starting medication. Changing the time of the dose may be helpful for some patients. An antacid may be helpful for some patients, especially those with reflux (antacids cannot be given within two hours of the fluoroquinolone dose; aluminum hydroxide reduces the effective RMP dose; proton pump inhibitors may reduce the conversion of PZA to its effective metabolite pyrazinoic acid). Alternatively, medications can be given with a small snack such as toast without butter or margarine, crackers, or a small piece of fruit. When these simple measures fail, an antiemetic can be given ½ hour prior to the medication dose. Usually patients become more tolerant of medication after several weeks. PZA often is the drug most likely to be responsible for gastrointestinal complaints and the patient may improve after the initiation phase of treatment with PZA is completed.125
Gastroparesis syndromes: emerging drug targets and potential therapeutic opportunities
Published in Expert Opinion on Investigational Drugs, 2023
Le Yu Naing, Matthew Heckroth, Prateek Mathur, Thomas L Abell
Antiemetic agents are often used in conjunction with prokinetic agents to treat the symptoms of GpS. Treatment with antiemetics aims to improve nausea and vomiting but does not result in improved gastric emptying or symptoms related to delayed gastric emptying as prokinetics do. In addition to those mentioned previously, other commonly used classes of antiemetic drugs include antihistamines and antimuscarinics. Antihistamines work by blocking histamine (H1) receptors in the CNS, including the area postrema and vomiting center of the vestibular nucleus. Antimuscarinics block the action of acetylcholine at muscarinic receptors (M1) in the same sites. The histamine receptor antagonists also carry central antimuscarinic activity, which further contributes to their antiemetic effects.
An update on the use of pharmacotherapy for opioid-induced bowel dysfunction
Published in Expert Opinion on Pharmacotherapy, 2023
Taraneh Mousavi, Shekoufeh Nikfar, Mohammad Abdollahi
Antiemetic agents used to manage opioid-induced nausea include prokinetic agents (e.g. metoclopramide), 5-HT3 receptor antagonists (e.g. ondansetron, granisetron, palonosetron, and dolasetron), anticholinergics (e.g. trimethobenzamide, scopolamine, and promethazine), antihistamines (e.g. meclizine, diphenhydramine, dimenhydrinate, and hydroxyzine), and corticosteroids (e.g. dexamethasone), cannabinoids (e.g. dronabinol and nabilone). In some cases, benzodiazepines (e.g. lorazepam) and neuroleptics (e.g. prochlorperazine, chlorpromazine, haloperidol, and olanzapine) might be used as well [68,69]. For instance, switching to neuroleptics is preferred in refractory cases or those with advanced cancer [70,71]. Additionally, using antihistamines and metoclopramide is reasonable for patients who suffer from nausea associated with vertigo or postprandial vomiting.
Brentuximab vedotin and bendamustine: an effective salvage therapy for relapsed or refractory Hodgkin lymphoma patients
Published in Journal of Chemotherapy, 2022
Bahar Uncu Ulu, Mehmet Sinan Dal, İpek Yönal Hindilerden, Olga Meltem Akay, Özgür Mehtap, Nurhilal Büyükkurt, Fehmi Hindilerden, Ahmet Kürşad Güneş, Tuğçe Nur Yiğenoğlu, Semih Başcı, Merih Kızıl Çakar, Didar Yanardağ Açık, Serdal Korkmaz, Turgay Ulaş, Gülsüm Özet, Burhan Ferhanoğlu, Meliha Nalçacı, Fevzi Altuntaş
Grade 3/4 haematological and non-haematological toxicities were defined according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events (NCI-CTC) version 4.0. Hematological toxicities were evaluated in the first week of BvB treatment. On the first day of the treatment, 30 min before the onset of Bv, 8 mg dexamethasone and 45.5 mg pheniramine maleate were administered as pre-medications for the patients. No pre-medication was administered before B on the second day of treatment. Antiemetic treatment was administered in case of nausea symptoms. Neutropenic patients received growth factor support during treatment. The response evaluation was assessed using PET/CT. Response evaluation was performed after at least two cycles of combination treatment. This assessment was repeated every two cycles following more than two cycles of treatment. PET-CT scans were evaluated four to six weeks after treatment for response assessment according to the Deauville five-point scale [15].